Llaquet Bayo Heura, Montmany Vioque Sandra, Rebasa Pere, Navarro Soto Salvador
Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España.
Cir Esp. 2016 Apr;94(4):232-6. doi: 10.1016/j.ciresp.2015.01.010. Epub 2015 Mar 21.
An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed.
A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included.
In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group.
Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients.
隐匿性气胸在2% - 15%的创伤患者中被发现。在这些患者中进行观察（不进行胸腔闭式引流）在临床实践中仍存在一些争议。本研究的目的是评估进行观察时的疗效和不良反应。
在我们中心（二级大学医院）进行了一项回顾性观察研究。数据来自一个进行前瞻性登记的数据库。纳入了2006年至2013年入住重症监护病房的1087例创伤患者。
在此期间，共识别出126例隐匿性气胸患者，73例（58%）患者立即接受了胸腔闭式引流，53例（42%）患者接受了观察。9例（12%）观察失败，因气胸进展或血胸而需要进行胸腔闭式引流。没有患者发生张力性气胸或出现与未进行胸腔闭式引流相关的其他不良事件。在接受观察的患者中，16例接受正压通气，在该组中有3例（19%）观察失败。观察组和未观察组在死亡率、住院时间或重症监护时间方面没有差异。
观察是隐匿性气胸的一种安全治疗方法，即使在正压通气患者中也是如此。
